Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

The case study is on a 76-year-old Iranian male patient that is suspected to have Alzheimer’s disease. The conclusion is based on the reports provided by his eldest son and there were no organic disease processes that were identified during the examination. The behavioral changes started two years ago, and included personality changes, apathy, which was followed by memory loss and challenges in finding the appropriate words during conversation. Confabulation is also noticed during the clinical interview, speech, and self-reported euthymic mood. The patient also has an impairment in his judgment and insight as well as absence of impulse control. There is no suicide ideation reported and the patient is diagnosed with neurocognitive disorder as a result of Alzheimer’s disease.

The first approach that will be taken will include Donepezil 5mg at bedtime. The use of donepezil among patients that have Alzheimer’s disease has been examined for decades. The medication is an acetylcholinesterase inhibitor, which increases the acetylcholine levels in the brain and compensates the reduced function of cholinergic neurons (Birks and Harvey, 2018). An assessment of randomized clinical trials analyzed the impact that donepezil has on patients with Alzheimer’s using randomized control trials. The findings showed that there is strong evidence that donepezil is effective in three major areas in the management of this condition, which include behavior, functional ability, and cognition (Li et al., 2018). These are the major areas that were affected in the patient and the goal was to limit their impact on his quality of life. As indicated in the case, he had significant personality changes that negatively impacted his engagement in activities of interest. However, there is a need to state that the National Institute of Aging has noted that there is still a poor comparison between different agents that are used as the first line of treatment for the patient (NIH, 2020).

The outcomes from donepezil differ as there can be development of complications along with limited clinical benefits. The patient complained of side effects such as loss of weight and appetite, vomiting, nausea, and diarrhea, which have been reported among patients using this medication (Kumar and Sharma, 2019).

The second decision was the use of cognitive behavioral treatment, which has been found studies to have a positive impact among patients with early stages of Alzheimer’s disease. Evidence supporting psychosocial interventions for patients with dementia has been identified in isolated cases (Forstmeier et al., 2015). However, there is still limited empirical data on these approaches. Some scholars have labelled behavioral interventions as appropriate among patients that have neuropsychiatric symptoms. Therefore, these will be used on the patient to improve behavior, and particularly targeted at reducing apathy and improving the self-control by the patient. Improvement of mood will positively impact the quality of life and the ability for the patient to engage in activities that will improve his cognitive status.

The third decision will be to include family members in the therapeutic process as this will help reinforce behaviors that will assist the patient. Studies illustrate that there is a high lack of adherence to care among elderly patients (Smith et al., 2017). This reduces the ability to evaluate the effectiveness of the interventions, as outcomes may be due to poor drug use. The goal is to increase the support system of the patient, and daily interactions as this has been found to positively impact the cognitive and emotional well-being of patients with dementia.